*Legalisation of Assisted Dying

 
The other night, I went to a lecture by Prof. Raymond Tallis on the 'Legalisation of Assisted Dying.'
 
He made the following distinctions, which I lifted from the dignity in dying website
(here: http://www.dignityindying.org.uk/about-us/our-policy-assisted-dying.html ).



Assisted dying (legalised and regulated in the US States of Oregon and Washington) only applies to terminally ill, mentally competent adults and requires the dying patient, after meeting strict legal safeguards, to self administer life-ending medication

Assisted suicide (permitted in Switzerland) allows assistance to die to chronically ill and disabled people who are not dying.

Voluntary euthanasia (permitted in the Netherlands and Belgium) allows a doctor to administer the medication directly to the patient.

Euthanasia is a term often used to describe life ending medication being administered by a third party, perhaps without the consent of the patient. 

He succinctly stated that he was for the legalisation of assisted dying as opposed to the other forms noted above. In his arguments he cited the inconsistent application of the 'autonomy principle' which is the right for persons to choose and manage their own autonomy. And the inconsistency of the 'sanctity of life' argument, how it becomes applicable in some cases but not in others.

The issue of end-of-life care has been a topic of debate in legislation within the UK. He cited examples from the states of Oregon and Washington as case studies and exemplars of the effects of enacting policies for assisted dying. He also mentions the policies in Switzerland, the Netherlands, and Belgium. I remember when I was attending my program at the University of Amsterdam they discussed quite thoroughly the policy of voluntary euthanasia.

Now I myself have no problems with these concepts, and would advocate that just as there is a right to life there is a right to death. Suicide is a critical existential question that any person should ask themselves and it becomes a good evaluator on one's position or outlook on life. Hume and may existentialists have written extensively on suicide as have some sociologists, most notably, Durkheim. Apart from the connotations of suicide, end-of-life care is an important dimension of the health care system. There is something reassuring about knowing when one is going to die and there is reassurance that one can live out the end of one's days in comfort and minimal suffering. It becomes a time to organize and tie up loose ends in one's life, meet the people one would like to meet and go about the end of one's life in the fashion one would like to go about it. One may make peace with some or take a victim's stance of nobody cares about me anyway or any other attitude about the end of one's life. Given the array of approaches health care is a system for the well-being and alleviation of some suffering for the people. Provide care for ailments and address issues that pertain to health.

The dynamics of health is interesting and even more intriguing when ethics come into play. My concern with assisted dying, assisted suicide, voluntary euthanasia, and euthanasia in general is the structures, resources, and policies that come into play. If a young adult wanted to commit suicide I believe the resources for that individual to talk to somebody prior to committing any regrettable actions is necessary. Resources should be available for individuals who would like to talk to a counselor or therapist. It would be a shame if many of the young adults who may later grow up to major contributors to society had committed suicide at a young age because he/she didn't know any better. Heart ache and failure can be quite devastating. But as in many things in life, things tend to get better as life goes on. And at times it doesn't always either. Nonetheless there should be resources available to provide a bigger scope of life for those who do consider the path of ending one's life. My other concern is the policies and structures that will implement these practices. And like I said, I have no particular problem with any of the proposed concepts and practices but rather potential problems with how the practice is implemented and the ramifications for insurance policies and whether there are incentives for the practitioners. There can be cases where doctors abuse the trust they have with their patients and deliberately convince their patients towards death. There may be financial benefits for doctors who conduct these practices. So my concern is not in the practice itself but the possible manipulation of patients by institutions and doctors who have major influences in the decision and understandings of health of these patients. If such policies are implemented I think there should be precautions of financial incentives for doctors and institutions who do conduct this practice as well as precautions against doctors who might enjoy the power trip of convincing somebody to end their own life. Cautionary measures should be taken for the development of malicious intent or financial gain over the interests of the patients.

Some other things that become problematic is definitional and how to define the parameters of the terms. One is the term "terminally ill" and the other is "mental competence." At what age does "mental competence" occur and when is it no longer "mental competence." This also goes for "terminally ill." All life must eventually come to an end. So what does the terms "terminally ill" include and exclude? Of course there are some answers that are obvious but there are also others that are progressively debilitating. Some are physically oriented and others are mentally oriented. Where does Parkinson's, Schizophrenia, depression, autism, or PTSD weigh in within the parameters of these terms? 

*just a thought, I wonder if part of the reluctance for endorsing assisted dying is in the people's underlying sense of hope that there will be a cure or that the loved one will get better. In this way, personal hope becomes a deterrent in the alleviation of suffering. There was also a question raised that I think becomes quite relevant not from a medical perspective but rather a social perspective. And that is the issue of social connections and kinship relations. If a loving wife or husband did not wish his/her spouse to die, even when it is his/her wish to end one's life earlier than the natural course of some terminal illness, what does the patient do?

*Update: The New York Times produced an article on 'Four Myths about Doctor Assisted Suicide'
(here: http://opinionator.blogs.nytimes.com/2012/10/27/four-myths-about-doctor-assisted-suicide/)